Survival impacts of different nodal characteristics and T-classification in N3 nasopharyngeal carcinoma patients

Tian-Yun Lin; Ming-Ying Lan; Hsiao-Hui Tsou; Ching-Yin Ho; Chih-Wen Twu; Yi-Chun Liu; Po-Ju Lin; Pin-I Huang; Cheng-Ying Shiau; Jin-Ching Lin

doi:10.1016/j.oraloncology.2020.104820

Survival impacts of different nodal characteristics and T-classification in N3 nasopharyngeal carcinoma patients

Oral Oncol. 2020 Sep:108:104820. doi: 10.1016/j.oraloncology.2020.104820. Epub 2020 Jun 9.

Authors

Tian-Yun Lin¹, Ming-Ying Lan², Hsiao-Hui Tsou³, Ching-Yin Ho⁴, Chih-Wen Twu⁵, Yi-Chun Liu⁶, Po-Ju Lin⁷, Pin-I Huang⁸, Cheng-Ying Shiau⁹, Jin-Ching Lin¹⁰

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
² Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
³ Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan.
⁴ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Otolaryngology, Cheng Hsin Hospital, Taipei, Taiwan.
⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan.
⁶ Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
⁷ Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan.
⁸ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁹ Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁰ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: [email protected].

PMID: 32531741
DOI: 10.1016/j.oraloncology.2020.104820

Abstract

Objectives: We investigated the survival impacts of various nodal characteristics and T-classification on nasopharyngeal carcinoma (NPC) patients with the 8th AJCC/UICC staging criteria N3.

Materials and methods: Pretreatment MRIs from 110 staged N3 NPC patients were reviewed. There were 23 T1, 25 T2, 32 T3, and 30 T4, respectively. All except one patient belonged to WHO type II pathology. All patients received curative radiotherapy 68.0-76.8 Gy plus different chemotherapy, including induction, concurrent, adjuvant or any combination. Various endpoints, including OS (overall survival), DFS (disease-free survival), LRFFS (locoregional failure-free survival), DMFFS (distant metastasis failure-free survival) were compared between different nodal characteristics and T-classification.

Results: There were no statistically significant differences in all analyzed survival curves between various nodal characteristics, including unilateral N3 vs. bilateral N3, "large" nodes (>6 cm) alone vs. "low" nodes (below the caudal border of cricoid cartilage) alone vs. combined "large" and "low" nodes, risk score 1 vs. 2 vs. 3 vs. 4 (by counting the sum of "large" and "low" nodes in the same case), and radiologic extra-nodal extension. Patients with T4, compared with those of T1-3 have worse OS (5-year rates, 42.2% vs. 82.8%, P < 0.0001), DFS (5-year rates, 43.9% vs. 68.9%, P = 0.0037), LRFFS (5-year rates, 69.3% vs. 82.7%, P = 0.0432), and DMFFS (5-year rates, 57.2% vs. 77.7%, P = 0.0163).

Conclusions: Our results support merging previous N3a and N3b as a N3 category in the 8th edition new staging system. Patients with T4N3 diseases have extremely poor outcome and deserve to strengthen the treatment intensity in future trials.

Keywords: Chemotherapy; N3 stage, radiotherapy; Nasopharyngeal carcinoma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Lymph Nodes / physiopathology*
Male
Middle Aged
Nasopharyngeal Carcinoma / classification*
Nasopharyngeal Carcinoma / mortality
Nasopharyngeal Carcinoma / physiopathology*
Retrospective Studies
Survival Analysis
Young Adult